Anesthetic Complications Research Articles

Comparison between the height of spinal block and the incidence of hypotension among surgical patients

Hypotension is one of the common complications of spinal anesthesia; caused by sympathetic blockade leading to reduced cardiac output. Hypotension may be associated with the height of spinal block and can reduce blood flow to organs thereby leading to cardiovascular collapse which may eventually lead to cardiac arrest if appropriate action is not taken. This study examines the relationship between the height of spinal block and development of hypotension. One hundred (100) ASA I and II patients whose surgeries were below the umbilicus and done under spinal anesthesia were enrolled for the study. Patients that had hypotension were recorded and the heights of block were also recorded. Eleven patients (11) had hypotension (11%) overall. The incidence of hypotension among groups T6, T8 and T10 were 25% (7), 18.75% (3)s and 2.04% (1) respectively with a p-value of 0.5 which was not statistically significant. This study has shown that the incidence of hypotension is directly proportional to the height of spinal block though it is not statistically significant at T6 and below.

(040) Local Anesthesia Only for Penile and Scrotal Procedures: A Prospective Analysis of Patient Tolerability as an Alternative to Sedation

Abstract Introduction Traditionally, urological procedures utilize general or spinal anesthesia (GA) in an operating room (OR) to achieve adequate periprocedural pain relief. However, this approach presents various obstacles, including high OR related expenses, difficulties in accessing healthcare in rural areas, higher risk of anesthetic related complications and long wait times for patients due to limited OR space. This is particularly evident in penile and scrotal procedures, which often receive non-urgent treatment and result in wait times exceeding six months in Canada. The use of local anesthesia (LA) only is an appealing approach that has been gaining more traction in recent literature – however, no study to date has evaluated patient-reported tolerability to procedures conducted in this manner. Objective To investigate the surgical outcomes and patient-reported tolerability of penile and scrotal urologic procedures performed solely under LA. Additionally, information regarding complications is collected to provide data regarding the safety of this method, offering a viable alternative without the need for sedation. Methods This prospective study is registered as a clinical trial NCT05617261. Adult patients undergoing penile or scrotal surgery under LA only have been enrolled since August 2022, and is ongoing until August 2023. Procedures of interest include hydrocelectomies, spermatocelectomies, epididymectomies, testicular biopsies, circumcisions and frenulectomies. For scrotal procedures LA is administered along the median raphe along with a spermatic cord block, and for penile procedures a subcutaneous ring and dorsal penile block is utilized. Demographics, surgeon- and patient-reported visual analogue pain scores (VAS), and surgical variables are collected. Patient tolerability to the procedure and future anesthetic choice for a hypothetical repeat procedure are assessed at a follow-up appointment as our primary outcome. Complication data is also collected including recurrence (if applicable), emergency room visits, excess pain, hematoma & infection. Statistical tests include analyses to determine associations between demographic or surgical variables and patient-reported outcomes. Results Thus far, 215 patients are enrolled with complete follow-up data and statistical analysis on 72 patients. The mean age ± SD is 42.2 ± 16.4 years and there has been a 100% success rate with no perioperative complications or conversions to sedation or general anesthetic. Table 1 highlights the current patient demographic differences between those who do or do not recommend LA. Table 2 describes VAS at each point in time. On follow-up, 93.1% of patients indicated they would opt for LA for a hypothetical repeat procedure, with Figure 1 illustrating this by procedure type. Of the minority opting for GA, only 2 patients did so due to excess pain – highlighting that patient tolerability is not a limiting factor; instead, a desire to have no memory of the procedure is prevalent in this small cohort. Conclusions LA only is a promising technique for various scrotal and penile urologic procedures with high levels of patient tolerability. As we continue our analysis, we anticipate minimal complication rates similar to existing literature and data highlighting cost savings to our public health care system with a substantial reduction in patient wait times and surgical and recovery times – allowing for increased surgical efficiency and accessibility. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Perioperative pain management in thoracic surgery and side effects in the early postoperative period

Aim. To study the impact of various methods of perioperative pain management on the frequency of postoperative complications in patients with lung cancer after thoracotomy. Materials and methods. The study involved 157 patients who were divided into 4 groups. Multimodal analgesia (MA) group: according to the concept of preemptive analgesia, patients received 1000 mg paracetamol IV 1 hour before surgery and 50 mg dexketoprofen IV; in the postoperative period, dexketoprofen and paracetamol were administered every 8 hours as well as epidural analgesia: 40 mg of 2 % lidocaine solution after a catheter was placed and continuous ropivacaine infusion at a dose of 2 mg/ml (6–14 ml/h) in the postoperative period. Thoracic epidural analgesia (TEA) group: epidural analgesia: administration of 40 mg of 2 % lidocaine solution after catheter placement, continuous ropivacaine infusion in the postoperative period at a dose of 2 mg/ml (6–14 ml/h). Preemptive analgesia (PA) group: according to the concept of preemptive analgesia – 1000 mg IV paracetamol 1 hour before surgery as well as 50 mg IV dexketoprofen; in the postoperative period, dexketoprofen and paracetamol were administered every 8 hours. Control group (C): patients received 50 mg IV dexketoprofen for postoperative analgesia. If the severity of the pain syndrome was more than 50 mm according to the visual analogue scale (VAS), patients of all groups were given 10 mg IV morphine. The study involved the registration of side effects in the postoperative period. Results. Among 157 patients, complications in the postoperative period were observed in 61 patients (38.85 %). The frequency of complications in MA group was 10.8 % of the total number of patients, in TEA group – 12.7 %, PA – 6.4 %, and in C group – 8.9 %. The most common complaint among TEA group patients was injection-site itching (13.5 %). PA group patients had a significantly lower number of complications compared to TEA group (p = 0.035). There was no statistically significant difference in the frequency of nausea or urinary retention in patients of all groups (p > 0.05). No difference was noted in the number of pulmonary complications depending on the method of perioperative analgesia (p > 0.05). 31 patients (75.6 %) of PA group did not have any complications, that was significantly different from TEA (p = 0.021) and MA (p = 0.039) patient groups. Conclusions. The use of paracetamol and dexketoprofen combination in the perioperative period allows to reduce (p = 0.035) the total number of postoperative anesthetic complications compared to the use of only thoracic epidural analgesia. The use of a multimodal approach combining epidural analgesia and administration of paracetamol and dexketoprofen does not reduce (p > 0.05) the overall frequency of complications compared to patients without epidural analgesia.

Management of paediatric sleep-disordered breathing.

Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

Effect of ultrasound-guided transversus abdominis plane block in reducing atelectasis after laparoscopic surgery in children: A randomized clinical trial

BackgroundAtelectasis is a commonly observed postoperative complication of general anesthesia in children. Pulmonary protective ventilation strategies have been reported to have a beneficial effect on postoperative atelectasis in children. Therefore, the present study aimed to evaluate the efficacy of the ultrasound-guided transversus abdominis plane (TAP) block technique in preventing the incidence of postoperative atelectasis in children. Materials and methodsThis study enrolled 100 consecutive children undergoing elective laparoscopic bilateral hernia repair and randomly divided them into the control and TAP groups. Conventional lung-protective ventilation was initiated in both groups after the induction of general anesthesia. The children in the TAP group received an ultrasound-guided TAP block with 0.3 mL/kg of 0.5% ropivacaine after the induction of anesthesia. ResultsAnesthesia-induced atelectasis was observed in 24% and 84% of patients in the TAP (n = 50) and control (n = 50) groups, respectively, before discharge from the post-anesthetic care unit (T3; PACU) (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.019–0.179; P < 0.001). No significant difference was observed between the control and TAP groups in terms of the lung ultrasonography (LUS) scores 5 min after endotracheal intubation (T1). However, the LUS scores were lower in the TAP group than those in the control group at the end of surgery (T2, P < 0.01) and before discharge from the PACU (T3, P < 0.001). Moreover, the ace, legs, activity, cry and consolability (FLACC) pain scores in the TAP group were lower than those in the control group at each postoperative time point. ConclusionUltrasound-guided TAP block effectively reduced the incidence of postoperative atelectasis and alleviated pain in children undergoing laparoscopic surgery.

Incidence of emergence delirium after homeostasis-guided pediatric anesthesia for ear-nose-throat surgery.

Emergence delirium is a complication of pediatric anesthesia during the early recovery period. Children undergoing ear, nose, and throat surgery are at high risk. The Pediatric Assessment of Emergence Delirium (PAED) scale is used for diagnosis and founded to specify the degree of emergence delirium. However, there is no consensus regarding a threshold value for emergence delirium diagnosis. Homeostasis-guided pediatric general anesthesia aims to maintain physiological parameters within normal ranges. In this prospective, observational study we evaluated the incidence of emergence delirium in children undergoing elective ear, nose, and throat surgery under standardized homeostasis-guided general anesthesia. Secondarily, we identified risk factors associated with an increased PAED score. In children aged 0-6 years, we collected data from standard monitoring, depth of anesthesia, and preoperative glucose and ketone body levels. These variables were studied as risk or protective factors for increased PAED >0 scores using multivariate logistic regression. Of the 105 children analyzed, only five children (4.7%) had emergence delirium according to a threshold PAED score ≥10, while 37 children (35%) had PAED scores >0. Statistical analysis of the PAED outcome identified two significant positive associations with pain (P<0.001) and preoperative blood glucose levels (P=0.006) and one negative association with preoperative ketone body levels (P<0.001). Our cohort observed a lower incidence of emergence delirium than in the literature. Higher pain intensity and lower blood glucose levels were risk factors for PAED > 0, whereas preoperative ketone body levels were protective.

Feeding tube use and complications in Prader-Willi syndrome: Data from the Global Prader-Willi Syndrome Registry.

Guidance on indications for, and types of, feeding tubes recommended in Prader-Willi syndrome (PWS) is needed. A Global PWS Registry survey was developed to investigate nasogastric (NG) and gastrostomy (G) tube use and associated complications. Of 346 participants, 242 (69.9%) had NG-tubes, 17 (4.9%) had G-tubes, and 87 (25.1%) had both NG- and G-tubes. Primary indication for placement was "feeding difficulties and/or poor weight gain" for both NG- (90.2%) and G-tubes (71.2%), while "aspiration/breathing difficulties" was the procedural indication for 6.4% of NG-tubes and 23.1% of G-tubes. NG-tubes were generally removed by age 6 months (NG Only: 82.9%; NG/G: 98.8%), while G-tubes were often removed by age 2 years (G Only: 85.7%; NG/G: 70.5%). The severe complication rate from G-tubes was 31.7% and from NG-tubes was 1.2%. Overall, caregivers indicated the presence of an NG- or G-tube had a positive effect on quality of life. Feeding difficulties in PWS are largely managed by NG-tube alone. The severe complication rate from G-tubes was about 25 times higher than from NG-tubes; yet, G-tube placement rates have generally increased. G-tube placement puts individuals with PWS at risk for anesthesia and surgery-related complications and should be considered judiciously by a multidisciplinary team.

A longitudinal study of the prevalence of post-surgical inguinodynia and the factors responsible for the development of chronic pain among the patients undergoing open hernioplasty at a tertiary care center

Background: Chronic groin pain (Inguinodynia) is a potential complication following inguinal hernia mesh repair and has a significant impact on the quality of life. The incidence varies among studies ranging between 0% and 62.9%. Aims and Objectives: The present study was conducted with the objectives of estimating the prevalence of post-surgical inguinodynia among the patients undergoing open hernioplasty. The secondary objective was to assess the factors associated with the development of post-surgical inguinodynia. Materials and Methods: A longitudinal study was carried out in a tertiary care center in Bangalore, Karnataka among the hernia patients attending the outpatient department of General Surgery department. A pro forma prepared with expert validation was used to collect details regarding pre-operative characteristics, type of anesthesia, intraoperative findings, and post-operative complications. The pain was assessed by the visual analog scale. Descriptive statistics and Chi-square test were used to identify the risk factors. Results: A total of 112 patients underwent hernioplasty. Out of this, 108 were males and 4 were females. The mean age of the patients was 48±10.8 years. Majority of them (84, 77.7%) presented with indirect inguinal hernia. The prevalence of inguinodynia at 3-month post-hernia surgery was 21.4% (n=24). Patients with significant pre-operative pain had higher chances of developing chronic pain (P=0.000). It was found that post-operative surgical site infection was associated with increased chances of development of chronic pain (P=0.000). Conclusion: Our study found that around one-fifth of the hernia patients had developed chronic post-surgical inguinal pain following open hernioplasty. There was no significant relationship between patients’ characteristics and development of chronic post-operative pain. The presence of pre-operative pain and post-operative infection in the patients was significantly associated with the development of chronic pain. Intraoperative nerve identification and chronic post-operative pain did not have a significant relationship in our study. Most of the patients who developed chronic pain had experienced only mild pain and none of them had severe inguinal pain. From the findings of our study, we would like to recommend that all measures must be taken to prevent and treat post-operative surgical site infection which leads to the development of chronic pain in patients.

Vocal Fold Paralysis After Spinal and Epidural Anesthesia: A Case Report and Scoping Review.

Cranial nerve paralysis is a rare complication of spinal and epidural anesthesia, and some cases of vocal fold paralysis (VFP) have been reported. The aim of this article is to report a case, identify evidence supporting the possibility of VFP being a complication of spinal and epidural anesthesia and to investigate the frequency, the characteristics, and the possible mechanisms of such a complication. CINAHL Complete, Google Scholar, Cochrane Library, Pubmed, and EMBASE. Case report according to CARE guidelines; scoping review according to PRISMA-ScR criteria. All types of studies that reported on patients of any age and sex, all types of spinal/epidural anesthesia regardless of the location and of drugs used were included. A data extraction sheet was completed for each study selected for inclusion based on the full-text screenings. Extracted data included: study characteristics, participant characteristics, intervention characteristics, outcome measures, clinical investigations. The study did not receive external funding. Eight studies met inclusion criteria and a total of 13 events (in 12 patients, including ours) were reported to date. Although there are some hypotheses in regard to the mechanism underlying the phenomena, including mechanical and inflammatory ones, the exact cause is still unclear. Only few cases of VFP after spinal or epidural anesthesia have been reported to date; however, it seems possible that VFP might be a potential underreported complication of such procedures. We believe that more research on the topic is warranted, especially considering the wide population potentially at risk. NA Laryngoscope, 134:3477-3484, 2024.

Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study.

The African Surgical Outcomes Study (ASOS) found that maternal mortality following cesarean delivery in Africa is 50 times higher than in high-income countries, and associated with obstetric hemorrhage and anesthesia complications. Mothers who died were more likely to receive general anesthesia (GA). The associations between GA versus spinal anesthesia (SA) and preoperative risk factors, maternal anesthesia complications, and neonatal outcomes following cesarean delivery in Africa are unknown. This is a secondary explanatory analysis of 3792 patients undergoing cesarean delivery in ASOS, a prospective observational cohort study, across 22 African countries. The primary aim was to estimate the association between preoperative risk factors and the outcome of the method of anesthesia delivered. Secondary aims were to estimate the association between the method of anesthesia and the outcomes (1) maternal intraoperative hypotension, (2) severe maternal anesthesia complications, and (3) neonatal mortality. Generalized linear mixed models adjusting for obstetric gravidity and gestation, American Society of Anesthesiologists (ASA) category, urgency of surgery, maternal comorbidities, fetal distress, and level of anesthesia provider were used. Of 3709 patients, SA was performed in 2968 (80%) and GA in 741 (20%). Preoperative factors independently associated with GA for cesarean delivery were gestational age (adjusted odds ratio [aOR], 1.093; 95% confidence interval [CI], 1.052-1.135), ASA categories III (aOR, 11.84; 95% CI, 2.93-46.31) and IV (aOR, 11.48; 95% CI, 2.93-44.93), eclampsia (aOR, 3.92; 95% CI, 2.18-7.06), placental abruption (aOR, 6.23; 95% CI, 3.36-11.54), and ruptured uterus (aOR, 3.61; 95% CI, 1.36-9.63). SA was administered to 48 of 94 (51.1%) patients with eclampsia, 12 of 28 (42.9%) with cardiac disease, 14 of 19 (73.7%) with preoperative sepsis, 48 of 76 (63.2%) with antepartum hemorrhage, 30 of 55 (54.5%) with placenta previa, 33 of 78 (42.3%) with placental abruption, and 12 of 29 (41.4%) with a ruptured uterus. The composite maternal outcome "all anesthesia complications" was more frequent in GA than SA (9/741 [1.2%] vs 3/2968 [0.1%], P < .001). The unadjusted neonatal mortality was higher with GA than SA (65/662 [9.8%] vs 73/2669 [2.7%], P < .001). The adjusted analyses demonstrated no association between method of anesthesia and (1) intraoperative maternal hypotension and (2) neonatal mortality. Analysis of patients undergoing anesthesia for cesarean delivery in Africa indicated patients more likely to receive GA. Anesthesia complications and neonatal mortality were more frequent following GA. SA was often administered to high-risk patients, including those with eclampsia or obstetric hemorrhage. Training in the principles of selection of method of anesthesia, and the skills of safe GA and neonatal resuscitation, is recommended.

Efeitos anátomo-fisiológicos da castração pré-púbere em felinos (Felis catus) – revisão de literatura

Pre-pubertal castration in felines is a highly effective strategy for managing stray animal populations, thereby benefiting both public health and animal welfare. It helps prevent unwanted pregnancies, minimizes human-stray animal conflicts, and curtails the spread of diseases transmitted through mating. However, this practice has sparked debates among veterinarians and pet owners due to potential adverse effects. Surgical and anesthetic complications, including hypothermia and hypoglycemia, are concerns during pediatric procedures. There is also a possibility of altered development of secondary sexual characteristics, although these changes typically do not impact the animals' overall well-being. Metabolically, neutered cats tend to gain weight, raising the risk of obesity and diabetes mellitus. Skeletal concerns involve delayed bone closure, yet bone density remains largely unaffected. Lower urinary tract issues, like incontinence or obstruction, may also arise, albeit through complex mechanisms. Despite these concerns, the benefits of pre-pubertal castration in managing overpopulation and reproductive diseases outweigh the risks. With vigilant veterinary care and post-operative management, adverse effects can be mitigated, underscoring the importance of this practice in controlling stray cat populations.

Maternal and perinatal outcomes of minimally invasive fetal surgeries: experience from two reference centers in Rio de Janeiro, Brazil.

Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. Retrospective cohort study conducted in two tertiary reference centers. This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.

Preoperativna procena rizika u pedijatrijskoj anesteziji

In general pediatric surgical population, the incidence of perioperative 30-day mortality is low. A child's physical status at the time of elective surgery and the presence of comorbidities can notably impact the perioperative risk. In order to provide quality care, preoperative evaluation should be undertaken in a timely and thorough manner. In preoperative period, it is highly important to be able to identify the patients who are at a higher risk, with the premise that early identification of these patients will allow for additional care to be provided, thereby minimizing possible complications. The main objectives of adequate preoperative assessment are to evaluate patients' readiness for the procedure, optimize patients' health status before surgery, reduce surgical morbidity, and help patients regain their usual functions postoperatively. Routine prescription of additional tests in children should be replaced by selective and rational prescriptions, based on the patients' history and performed clinical evaluation. Surgical and anesthetic complications can have adverse effects on patients' health, and they have also been proven to be associated with increased inpatient and postoperative costs. Each member of the surgical team plays a vital role in the safe care of pediatric patients. Well known risk factors for critical events in the perioperative period in pediatric population are as follows: ASA physical status, age, emergency surgery, and the existence of an underlying disease. This review highlights potential risks encountered in children and directs preoperative assessment towards selecting essential tests based on identified individual risk factors.

Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report

Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report

Effectiveness of general anaesthesia with remimazolam tosilate on intraoperative haemodynamics and postoperative recovery: study protocol for a randomised, positive-controlled, pragmatic clinical trial (GARTH trial)

IntroductionIt is encouraged to estimate the effectiveness of components within the enhanced recovery after surgery (ERAS) protocol through patient-reported outcomes, alongside doctor-reported outcomes and length of hospital stay. At present,...

Anesthetic Techniques and Complications, Challenges in Hysterectomies in Obese Patients

Anesthetic Techniques and Complications, Challenges in Hysterectomies in Obese Patients

Development of a Simple and Reproducible Cell-derived Orthotopic Xenograft Murine Model for Neuroblastoma.

Neuroblastoma is a common childhood cancer with poor survival for children with high-risk disease, and ongoing research to improve outcomes is needed. Patient-derived xenografts (PDX) and genetically engineered mouse models (GEMM) are reliable models for oncologic research; however, they are resource-intensive, expensive, and require significant expertise to develop and maintain. We developed an orthotopic xenograft murine model of neuroblastoma that utilizes cryopreserved banks of human neuroblastoma cell lines, requires minimal equipment, and is easily reproducible. The neuroblastoma cell line NB1643 was obtained from the Children's Oncology Group (COG) Childhood Cancer Repository. Nod-SCID-gamma (NSG) mice underwent orthotopic injection of 2x106 NB1643 cells suspended in 10 μl of collagen hydrogel directly into the adrenal gland via an open retroperitoneal surgical approach. Mice were monitored by ultrasound and in vivo imaging system (IVIS) until the tumor reached the volume of the ipsilateral kidney. Tumor identity was confirmed by necropsy and histologic analysis. A total of 55 mice underwent surgery. Eight died due to anesthetic or surgical complications. 39/47 (78%) survivors grew primary adrenal tumors. Average anesthesia time was 30 min. Ultrasound and IVIS successfully characterized tumor growth in all mice. Average time to target tumor size was 5 weeks (range=3-9). Gross pathologic and histologic analysis confirmed adrenal tumors consistent with neuroblastoma in all mice with adrenal masses. A cell-derived orthotopic xenograft murine model can be successfully used to create an in vivo model of neuroblastoma. This model can be utilized in environments where PDX or GEMM models are not feasible.

Retrospectif Analysing of Anesthesia Manegement in Robotic Assisted Radical Prostatectomy Cases

Aim: In our study, we aimed to investigate anesthesia management, hemodynamic changes and complications that may ocur due to steep trendelenburg, pneumoperitoneum and sugery in RARP patients operated in A.U.T.F, and to evaluate our initial results.&#x0D; Methods: Patients who underwent RARP operation with the diagnosis of prostate adenocarcinoma by the Urology Clinic at Akdeniz University Faculty of Medicine between January 2015 and February 2018 were evaluated retrospectively. Patient’s demographic data, intraoperative hemodynamic and respiratory data, postoperative transfer sites, extubation times, post-extubation blood gas values, complications and discharge times were recorded. Obtained data were analyzed with IBM SPSS® 23.0 program.&#x0D; Results: We found that mean age of the 131 patients included study was 62 years, and mean BMI was 27,6 kg/m2. Also we found that 47 of patients were ASA-I, 69 of patients were ASA-II and 15 of patients were ASA-III. After general evaluation, it was seen that HR, SBP, DBP and MAP decreased significantly in intraoperative period in all patients. There was also a significant decrease in pH and increase in pCO2 in patients due to pneumoperitoneum. In our study, we found thah the most common postoperative complication was nause and vomiting, and the second common was anastomotic leakage. However, none of our patients had a permanent complication. &#x0D; Conclusion: In order to manage anesthesia in RARP, it is necessary to know the physiologic effects of trendelenburg position and pneumoperitoneum on the systems and physiological changes in old age.

Sezaryen yapılan Türk ve göçmen hastalarda anestezi sonuçlarının karşılaştırılması

Aim: Our study aims to compare anesthesia complications between immigrant and Turkish patients thus better knowledge to clinicians and anesthetists for the management of cesarean operative delivery among different race obstetric populations. Materials and Methods: Between 06.2018-08.2018, cesarean anesthesia forms were examined retrospectively. Age, gestational week, indication of surgery, anesthesia method applied, complications in mother (hypotension, bradycardia, bleeding, emesis) recorded. Results: 143 Turkish and 145 immigrant patients were recruited for our study. ASA II score, emergency cesarean (CS) rate, emesis incidence, hypotension rate of patients were statistically higher in immigrant patients than in Turkish patients (p&amp;lt;0.05). There was statically no significant difference found between the two groups of patients on behalf of bradycardia. Conclusion: We highlight the barriers to emergency cesarean section operations in the un-monitored obstetric population, so it is vital to raise awareness of both obstetricians and anesthesiologists on this issue.